Topic: Intrahepatic biliary injuries associated with RFA

Intrahepatic biliary injuries associated with radiofrequency ablation of hepatic malignancies

http://www.ncbi.nlm.nih.gov/pubmed/22088453

2 (edited by PCL1029 Fri, 09 Dec 2011 12:53:10)

Re: Intrahepatic biliary injuries associated with RFA

Hi,eli.
Well  I can say one thing about you, you make me work harder,you make me study more about treatments and alternatives for CCA; for this I am thankful. Like Gavin,your devotion is well appreciated by all of us and especially me.
I do not agree with the study from the point of view as a CCA patient. it seems to me that the study is more concern about the damage of the bile ducts by RFA than the more positive results that RFA can provide to  intrahepatic CCA patients like me . Dose the study mean that bile duct cancer patient,like me, should not have RFA procedure because it will damage our bile ducts in the liver? Liver can regenerate and so will be the bile ducts.  This is not a good study and as always everyone should know that  not  all the studies are equal of importance.
Even the study  itself concluded the 1.8% of adverse reaction of the RFA procedure and the damage to the bile ducts will not affect the long term survival .
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Intrahepatic biliary injuries associated with RFA

I remember a highly regarded physician stating:
"Just because it is a study - it does not mean that it is a good study."

We are fortunate in that information has become easily accessible to us – the drawback though is that unless trained in the field we simply do not have the knowledge to correctly interpret the given information - that demands the expertise of a specialist.

For that reason alone I will always own a printer.  Similar to you Eli, my briefcase was filled to the rim when visiting the physician.  We did notice that were given the appointments right after lunch, never in the morning, and never were we scheduled last of the day.  It made us chuckle.

Hugs and all my best wishes,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Intrahepatic biliary injuries associated with RFA

Percy... let me respectfully disagree with your criticism of this study.

PCL1029 wrote:

it seems to me that the study is more concern about the damage of the bile ducts by RFA than the more positive results that RFA can provide to intrahepatic CCA patients like me.

That was the explicit goal of the study. The benefits of RFA are well known. The data about injuries is limited. They wrote: "This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation."

PCL1029 wrote:

Dose the study mean that bile duct cancer patient, like me, should not have RFA procedure because it will damage our bile ducts in the liver?

No, the study doesn't say anything like that. Their conclusion was: "The incidence of biliary injury was not frequent (1.8%). Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients' long-term survival."

As a patient, how can you give an INFORMED consent if you don't know the risks and their incidence rate?

Before we signed the consent to do Whipple, the surgeon told us the % of patients who develop pancreatic leaks. Before we signed the consent to do 3D radiation, the radiation ONC cited the incidence rates of spinal injuries and compromised surgical connections. The numbers came out of studies similar to this one.

Really, I don't see anything controversial about this study.

Re: Intrahepatic biliary injuries associated with RFA

Marion... that's a funny observation. I wonder how long your typical appointment lasted?

Ours don't last very long. 30 minutes tops. Our medical oncologist is always very rushed. We never feel welcome to explore all questions we have. I don't put blame entirely on his shoulders. He has a large waiting room filled with patients. I blame the system that sets unrealistic patient to doctor ratio.

Re: Intrahepatic biliary injuries associated with RFA

Eli, I am trying to remember back when Teddy was told he was to have a Whipple. I honestly believe that most of us don't have the time to research nor is that paramount on our minds compared to the shock we have just been given. We were out of town visiting our children in Milwaukee. I had no time to research a Surgeon, nor to look up facts. Teddy was in such dire straights that we only had 4 days from DX to surgery. We totally lucked out on our Surgeon, he was the best. Unfortunately Teddy had to go through it twice, first was aborted after 4 hours,  with a double e coli infection in between the 2 surgeries. Our 2 week visit turned in to 3 months! I would venture a guess that MOST of our members do not do radical research, the brain is already on over load with the shocking news. This does not make them bad advocates or bad patients. It's just that life has a lot of gray areas not all black and white. I do know that 4 prominent  Doctors all agreed to no chemo/rad not only because of his clear margins but because they felt at the time it would only put him through more that in the end would not matter. They were right. A year ago July when we got the 'final' words we went back to see the kids in Milwaukee and it was very important to Teddy to thank the original surgeon. He did and the Surgeon said to him, "I can tell you now Teddy, I didn't think you would make the first year". So glad he never told us that.
All the research is wonderful and much appreciated but in the end this CC is such a puzzle that there are few members who have everything happen the same way. That makes it even harder to study the studies.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

7 (edited by PCL1029 Fri, 09 Dec 2011 23:55:54)

Re: Intrahepatic biliary injuries associated with RFA

Hi,Eli,

That is why I said in previous messages,yor are a  very detail oriented person.
I KNOW you will do fine in researching for your wife.
And you will see and study the information at hand and link them together to get the most out of each article you research.in that way ,you will get a bigger and better picture for finding the best treatment for you wife.
The study ,like you said, is not controversial; but for me, practically,it is not very useful in terms of for treatment of CCA patients,like me.
BTW,what Lainy said applied to me also, I did not do any research on my liver surgeon,I just trust my oncologist' recommendation. It turns out he is the one,after the resection,my GI surgeon friend would recommend too . Things happened so unexpectedly that even I know 2 nd opinion is an option I should do but I did not seek.
With regard to the length of appointment, you got 30 min. ; well the longest I got so far is about 15 min.




God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Intrahepatic biliary injuries associated with RFA

Hi Percy! I think we need to go to sleep now!  There was nothing on TV tonight!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Intrahepatic biliary injuries associated with RFA

Hi,Lainy,
I think sometimes a person's gut instinct can serve him/her well in situations like that. For myself,as a Christian, that is God's Grace to give me a good surgeon without asking Him. For others, it may be called lucky.

of course,if a patient or caregiver have the ability to have the time  and will to do research before hand,this is the BEST way to Fight any disease. (like Treejay' s successful story in caring of his mom.)

Sorry,Lainy, I did go to bed before you did, and thanks for the beautiful poems you wrote for Devasated on the passing of her husband.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Intrahepatic biliary injuries associated with RFA

Good Morning Percy. Yes, my gut served me well. I always say I graduated from GUT101!!!!! And you are so right about God's intervention. Teddy used to say to the Surgeon, "I prayed for God's hands to come through yours!". OK, now I am getting sentimental but Teddy NEVER prayed for himself. He prayed that we would all stay strong. Sorry, having a Teddy moment!
smile

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Intrahepatic biliary injuries associated with RFA

Good morning Lainy,

You wrote:

I would venture a guess that MOST of our members do not do radical research, the brain is already on over load with the shocking news. This does not make them bad advocates or bad patients.

Amen to that!

We all try to do our best, whatever we think that "best" is. We all come from different backgrounds. We all have our unique personalities. It's only natural that we approach the same challenge from different angles. There is no right way or wrong way. Is "radical research" (as you put it) necessary? Of course not. Should every caregiver make an effort to do the research? Of course not. Should anyone think less of themselves if they don't feel up to it? Of course not. Not for one second.

Lainy... I will be the first to tell you that, as a caregiver, I'm far from perfect. I'm lousy at certain aspects of caregiving that are more important than research. Things like being a good cheerleader for my wife, keeping her spirits up, making her laugh, distracting her from her bad thoughts, etc. I'm cerebral and introverted. The emotional side of caregiving is not my strength. I'm sure that MOST caregivers on this board are way better at that than I'm.

We all try to do our best. That's all that counts.

Peace,
Eli

Re: Intrahepatic biliary injuries associated with RFA

Eli....going back to your question as to how long our appointment lasted - it never seemed quite long enough and it always left some questions unanswered, but only those we did not think of in the first place. 
Many years ago when my youngest son was diagnosed with a serious heart condition (he had two corrective surgeries and is doing exceptionally well) our cardiologist welcomed my inquisitive questions to which always he responded in a kind and caring manner. 
One day though he turned to me with a smile and said: "Mrs. Schwartz, it took many years of training for me to obtain this knowledge - in no way am I able to pass on to you everything I have learned."  I appreciated that.
Like you I need to understand, in depths, what it is I am dealing with so that I can accept and go along with what is presented to me.  But I also have come to realize that there are times when simply that is not possible.
We live in an age where we are encouraged to become strong advocates and yet when we take on this role, we come to realize that always we are left with unanswered questions or that we don't have the knowledge to ask the questions in the first place. 
What I am trying to convey to you is that it is highly unlikely for any of us to become experts in the field of Cholangiocarcinoma however; given the vast amount of information available to us we are in a much better position than we had been as little as five years ago. 
That is the reason I believe that support groups such as ours are immensely popular because they give us the opportunity to share information (amongst many other things) and they allow us to interact, agree, and disagree with statements made by others.  As they say:  “Knowledge is Power.”  That power though brings with it a certain amount of limitations in that we may be misinformed, under informed, or even wrongly informed.   If we can’t assimilate the given information then we are apt to be misinformed.  So, it is a heck of a place to be in.
I also wanted to comment on your last statement in regards to your misgiving of not being everything you believe you should be to your wife. I strongly disagree with you because; what you are doing is immensely helpful to her.  She knows that a fighter is by her side.  You are a warrior.

All my best wishes,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Intrahepatic biliary injuries associated with RFA

Marion, I just want to say, about your son, I know for a fact he is doing well and not only that but if I may, he is so very handsome and just that nice as well!!!!!!!!! The apple did not fall far from the 2 trees!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Intrahepatic biliary injuries associated with RFA

Thanks, Lainy.  Did I tell you that my son liked you very much also and that he enjoyed our night out?  And, here I thought that he was polite in saying so but, later that evening I overhead him talking about it to a friend.  Guess, we still are good company.

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER